A Call for Race-Based Data in Canadian Public Health Crises

Despite the link between health inequities and marginalized populations, there is a significant lack of race-based demographic data in Canada. This gap has been highlighted by previous public health crises and most recently by the COVID-19 pandemic, which has significantly affected many ethnic groups. Unfortunately, Canada has had sparse reporting of equity-related indicators for COVID-19, with a lack of reporting on outcomes according to factors like race/ethnicity, income, or education by any province or territory.¹ At the same time, multiple sources have commented that COVID-19 has disproportionately affected lower-income communities often containing higher numbers of immigrants and racialized populations.^1-3 

Why are marginalized ethnic groups at higher risk?
For several reasons, these ethnic groups are at higher risk for increased disease burden and negative health outcomes due to COVID-19.  Individuals in these communities tend to live in multigenerational homes in clusters of neighbourhoods; struggle with lower income and fewer educational opportunities; often work in frontline industries; and have language and cultural barriers that limit their health literary and access to medical care and material resources.^2,3  Some ethnic groups also have increased burden of chronic medical conditions like some malignancies and cardiovascular disease.⁴  At baseline, these individuals already face numerous health inequities, which are further augmented in moments of public health crises.⁵  Furthermore, because ethnic groups are underrepresented among study participants in the research on COVID-19 burden and outcomes, the current findings likely understate the inequities they face.³  

What are the benefits of race-based data?
Transparency in the collection and publication of race-based data may strengthen the public health efforts to protect these communities.  Standardized collection, distribution, and analysis of this information would enable more efficient and effective targeting of education and public health strategies.  This data could also spur community-led initiatives from local leaders, organizations, and religious groups, which would be especially helpful in reaching at-risk individuals using different communication strategies in their familiar languages.  Furthermore, race-based data can help us better understand the experiences that marginalized individuals face during public health crises, which in turn can translate to improved strategies to eliminate, rather than ignore, the social inequities faced by these communities.  There is a need for higher priority assessment of the racial and ethnic disparities in this pandemic to help reduce the disproportionate disease burden of COVID-19.⁶

What are some ways we can prevent stigmatization due to race-based data?
Even when race-based data has been collected in Canada, there has been reluctance in sharing this information for fear of stigmatizing ethnic populations, particularly those with higher COVID-19 infection rates. If race-based data is not contextualized with adequate analysis, interpretation of these data sets runs the risk of attributing health disparities to biologic causes and stereotypical racist behavioural patterns.⁵  A lack of contextualization can also lead to territorial stigmatization, in which broad assumptions are made about marginalized neighbourhoods, who often already have limited access to material resources and medical care.⁶ Accordingly, race-based data must be shared in ways that protect marginalized groups from stigmatization.  There needs to be a focus on education rather than blame, especially when trends of increased disease burden and health outcomes are noted.  Race-based data should include other indicators of socioeconomic status that contribute to inequality, including income, food insecurity, household conditions, and neighbourhood factors.  The more we know, the more we can help battle racial health disparities in public health crises like the COVID-19 pandemic.

References

1. Blair A, Warsame K, Naik H, Byrne W, Parnia A, Siddiqi A. Identifying gaps in COVID-19 Health Equity Data Reporting in Canada using a scorecard approach. Canadian Journal of Public Health. 2021;112:352-362.  doi:10.1101/2020.09.23.20200147 
2. Fagan E. Race-based data crucial in combatting COVID-19, experts say. Race-based data crucial in combatting COVID-19, experts say - The Globe and Mail. . Published August 15, 2021. Accessed November 1, 2021. 
3. Borno HT, Zhang S, Gomez S. Covid-19 disparities: An urgent call for race reporting and representation in clinical research. Contemporary Clinical Trials Communications. 2020;19:100630. doi:10.1016/j.conctc.2020.100630 
4. Haynes N, Cooper LA, Albert MA. At the heart of the matter: unmasking and addressing the toll of COVID-19 on diverse populations. Circulation. 2020;142(2):105-107. doi:10.1161/circulationaha.120.048126 
5. Chowkwanyun M, Reed AL. Racial Health Disparities and covid-19 — caution and context. New England Journal of Medicine. 2020;383(3):201-203. doi:10.1056/nejmp2012910 
6. Wacquant L. Territorial stigmatization in the age of advanced marginality. In: Wacquant, L. ed. Symbolic Power in Cultural Contexts. 2008:43-52. doi:10.1163/9789087902667_006